Healthcare Provider Details

I. General information

NPI: 1710442629
Provider Name (Legal Business Name): JAMIE LEE PIEKARSKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N 12TH ST # 704
BROOKLYN NY
11249-1002
US

IV. Provider business mailing address

109 N 12TH ST # 704
BROOKLYN NY
11249-1002
US

V. Phone/Fax

Practice location:
  • Phone: 860-406-4730
  • Fax:
Mailing address:
  • Phone: 860-406-4730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402699
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number715015-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: